Stafford Hospital: Hiding mistakes 'should be criminal offence'

 

"A story of appalling suffering": Watch Robert Francis QC's statement in full

NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.

Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.

But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.

He made 290 recommendations, saying "fundamental change" was needed to prevent the public losing confidence.

His report comes after the families of victims have voiced anger that no-one has been sufficiently punished for their roles.

Senior managers were able to leave the trust with little sanction, while most doctors and nurses involved have escaped censure from their professional regulators.

Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.

He said he was "truly sorry" for what happened at Stafford Hospital, which was "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency.

Mr Cameron said a full response to the inquiry would follow next month, but he did immediately announce that a new post of chief inspector of hospitals would be created in the autumn.

Previous investigations have already established in harrowing detail the abuse and neglect from 2005 to 2008.

This inquiry looked at why the system did not prevent the problems or at the very lest detect them earlier.

The Mid Staffs public inquiry

  • The public inquiry is the fifth major investigation into what happened
  • It has focused mainly on the commissioning, supervision and regulation of the trust from 2005 to 2009 - something campaigners felt had not been properly covered before
  • It was chaired by Robert Francis QC, who also led the fourth major investigation
  • It sat between November 2011 and December 2012 and cost £13m
  • More than 160 witnesses appeared at the hearings and one million pages of evidence have been sifted through
  • The final report contains 290 recommendations over nearly 1,800 pages.

In particular, it recommended:

  • The merger of the regulation of care into one body - two are currently involved
  • Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
  • Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
  • A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
  • An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors
'Remote'

While it is well-known the trust management ignored patients' complaints, local GPs and MPs also failed to speak up for them, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough.

Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.

The Department of Health was also criticised for being too "remote" and embarking on "counterproductive" reorganisations.

The report said the failings created a culture where the patient was not put first.

Start Quote

This is a story of appalling and unnecessary suffering of hundreds of people”

End Quote Robert Francis QC

But the inquiry said the change needed did not require further reform.

Instead, it urged everyone from "porters and cleaners to the secretary of state" to work together to shift the culture and adopt a "zero tolerance" approach to poor care.

Mr Francis said: "This is a story of appalling and unnecessary suffering of hundreds of people.

"They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety."

He said the public's trust in the NHS had been "betrayed" and a change of culture was needed to "make sure that patients come first".

Target driven

The "appalling" levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.

They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.

Time to care?

James Moore, who has left the NHS after working in A&E for 15 years, said reports of abuse made him "ashamed to be a nurse".

He blamed poor management rather than nurses no longer caring.

He drew parallels with being a waitress: "The restaurant gets busier, the waitress works harder and harder with the same resources and things start getting missed, she drops a meal here or there and people don't get their food on time and complaints are made".

Instead of dealing with the workload he said managers made the problem worse: "They'll ask the waitress to fill out more forms to tick that she's done certain things, then the restaurant gets busier and busier and the nurse has more and more forms to fill out."

Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.

Cases have also been documented of patients left crying out for help because they did not get pain relief and food and drinks being left out of reach.

Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment.

There has been anger from some quarters after nobody lost their jobs as a result of the public inquiry.

James Duff's wife Doreen died in the hospital. He said: "Not one person has lost their job over this - instead they have been promoted and some people have been moved sideways.

"This has been a disaster yet nobody is accountable."

Sir David Nicholson has the focus of anger from families affected by the scandal. He is chief executive of the NHS and was briefly in charge of the Regional Health Authority while death rates were high at Stafford Hospital.

He responded to calls for him to go saying: "I think it's perfectly understandable, I understand the anger that they feel, the upset that they feel about the treatment of their loved ones in Mid-Staffordshire hospital.

"I absolutely understand all of that. At the time I apologised and in a sense I apologise again to the people of Stafford for what happened, but apologies are not enough.

"We need action, we need to make things happen."

Reaction

Royal College of Nursing general secretary Peter Carter described it as a "powerful and monumental" report.

He said: "We welcome moves for overarching standards which enshrine what patients deserve from the NHS and from those who work for it.

"Appalling care cannot be tolerated and everything should be done to ensure that it does not happen again."

But campaigner Julie Bailey whose mother, Bella, died in 2007 at Stafford Hospital prompting her to set up Cure the NHS, which had been instrumental in pushing for the public inquiry, called for resignations.

"We've lost hundreds of lives in the NHS and we want accountability.

"We owe that to our society and to the deaths and the respect of all the loved ones that we have lost.

"We will go nowhere until we get accountability."

Katherine Murphy, the chief executive of the Patients Association, said the report was a "watershed moment" for the health service.

She said: "It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.

"It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability."

BBC West Midlands special investigation, The Hospital That Didn't Care, on BBC One at 10.35pm on Wednesday, 6 February.

 

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  • rate this
    +12

    Comment number 110.

    A considerable portion of the blame for what happened in Stafford is down to politicians of all parties. Pointless reorganisation of the NHS appears to be a rite of passage for every administration elected. If NHS staff are to face prosecution if they are not open and honest about mistakes, then this rule must apply to MPs too as they are past masters at dodging accountability

  • rate this
    +28

    Comment number 109.

    I doubt poor care at Stafford Hospital was caused by a lack of caring. NHS nurses and doctors are overworked all over the UK, with various irrelevant bureaucratic tasks to be completed, and pointless change going on all the time that everyone is supposed to embrace. Whistleblowers are not truly encouraged. The watchdog body CQC is more concerned with paper evidence than that of its own eyes.

  • rate this
    +4

    Comment number 108.

    This report went "straight to the top of health service". and therefore those in charge should be sacked and that includes Andy Burnham as 'shadow health minister' on whose watch this happened. Ed Milliband dare not say ever again his mantra "NHS not safe in Tory hands"; its obviously wasn't safe in Labour's hands and please Ed don't get up in Westminster telling the PM "this/that should be done.

  • rate this
    +47

    Comment number 107.

    Unfortunately although a severe case the Stafford experience is by no means isolated. Having had dealings with three different hospitals in three counties over the last five years in respect of a husband with dementia, the lack of care, dignity and just plain respect beggars belief. Lets stop nibbling at the edges of the problem and get back to the basics of a patient driven culture.

  • rate this
    +103

    Comment number 106.

    Appalled to note that as soon as the PM stood up to make his statement, more than half of MPs on both side of the House left to get lunch. Given that MPs are criticised for not doing enough about the issue, I find it appalling that so many of those who are meant to represent us the voter could not be bothered to stay and listen.

  • rate this
    +2

    Comment number 105.

    Anothe media circus descends on another crisis of confidence. The Press, the Police, The Banks - and even The BBC. Who is next? These are all organisations in which human beings have proved that they are just that.- Human beings. We are led to believe that our institutions are perfect, and when this is proved to be the case we go to pieces. The only people who prosper are the Legal profession!

  • rate this
    +4

    Comment number 104.

    Pt 2:
    My wife’s a HCA (not at Staffs) paid £7.42/hr, attending to patients as best she can, despite regular short staffing, patient dementia and regardless of norovirus, diarrhoea and vomit. In her workplace the culture is already one of heightened responsibility and accountability - at the bottom of any power structure, either you're responsible and accountable or you lose your job.

  • rate this
    +3

    Comment number 103.

    The govt makes the rules and passes them as Acts of Parliament = laws.
    The Dept of Health create the beaurocracy , the management are now legally obliged to instigate the systems and the workers are demoralised by the burden.
    The starting point is the Govt and Dept of Health.

  • rate this
    +5

    Comment number 102.

    The same governance should be applied to politicians.

  • rate this
    +5

    Comment number 101.

    As long as politicians can also be prosecuted for their dissembling and ideologically based interventions and interference. E.g. who came up with the idead that nurses should have degrees rather than a strong vocational interest and a caring approach? Who has lumbered the NHS with endless targets, turning management into a damage limitation exercise rather than allowing it to focus on patients?

  • rate this
    +6

    Comment number 100.

    It is cheaper to spend £1 on a marketing campaign to say how good the service is (remember the slogans...the patient is at the forefront of everything we do) than to spend £100 actually making it a good service. Thank goodness we are getting back to reality of what is actually going on. We want this report implemented in full - including the hospital board being sacked if care standards fall.

  • rate this
    +2

    Comment number 99.

    Imagine how much more the BBC would have reacted if this was done by a private comany. We need the BBC more than ever to get stuck in to this. Not at the sidelines. We need huge investigations inti this.

  • rate this
    0

    Comment number 98.

    @63.squirrel
    "My advice to anyone thinking about getting ill is Don't! But if you find you really have to get ill, just make sure it's only a 'little bit'..."

    "Never catch anything you can't spell, in case you have to write a note."

  • rate this
    +3

    Comment number 97.

    Having seen at close hand, the fairly despicable approach of some of the 'management consultants' in parts of the NHS, what a real surprise all this isn't.

    But all that will happen now, with an enforced 'culture of openness', is blaming of the lowest level people in the organisation whilst the real shouty monsters at the top either leave with a fat payoff or, worse, stay and carry on shouting.

  • rate this
    +3

    Comment number 96.

    //Megan
    Perhaps it is time that hospital administration was treated as a profession, with specific qualifications and a professional body - in front of whom those who botch up can be summoned & 'struck off' if found to have misbehaved.//

    A good point, which I'd extend throughout the public - and private - sector.

  • rate this
    +1

    Comment number 95.

    Yet again we talk about an inspector being appointed! The nhs has enough inspectors and they are as shown able to manipulate figures to support the flavour of the month.. What is needed is the public to be able to speak out and staff to take part in quarterly surveys to have their say as a way to monitor trusts. This is happening in some shape or form in all hospitals up and down the country!

  • rate this
    +2

    Comment number 94.

    Sod that - it should be a crime in ALL of the Public sector to cover up mistakes that cause patients/clients a problem AND it should also be illegal to cover up equivalent mistakes in ALL of the Private Sector too...

    ....including problems created in other countries by British trading firms.....

  • Comment number 93.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this
    0

    Comment number 92.

    Much of the worst abuse and negligence occurred at the time money was being thrown at the NHS hand over fist and the govt of the day was constantly claiming improvements to service based on rosy statistics. The fault lies both within and outside of the NHS

  • rate this
    +2

    Comment number 91.

    Many public entitys are IMMUNE from criminal prosecution, this needs to change.

    Fact is, in every profession there are those that are terrible, whether plumbers, MPs, Police, teachers, nurses, doctors, exec directors.

    NHS is so vast, 2%, attrocious employees, have MAJOR consequences.

    The cuts/changes to NHS SHOULD have been FIRSTLY used to weed out incompetants at ALL levels

 

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